Emergency Rules

MaineCare Benefits Manual, Chapters II & III Section 65, Behavioral Health Services

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The Department of Health and Human Services (Department) adopts the following emergency rule changes in 10-144 C.M.R. Ch. 101, MaineCare Benefits Manual, Chapters II and III, Section 65, Behavioral Health Services. In Chapter III, the Department is increasing the rate of reimbursement for Medication Assisted Treatment with Methadone (MAT) retroactive to July 1, 2019. Pursuant to P.L. 2019, Ch. 343, An Act Making Unified Appropriations and Allocations for the Expenditures of State Government, General Fund and Other Funds, and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government for the Fiscal Years Ending June 30, 2019, June 30, 2020 and June 30, 2021, (effective June 17, 2019), the Legislature increased funding for the weekly reimbursement rate for MAT services for the FY2020 and FY2021 state budgets. In light of the state's ongoing opioid crisis, the Department finds that the immediate adoption of the MAT rate increase is necessary to avoid an immediate threat to public health, safety, or general welfare under 5 M.R.S. 8054. The emergency rate increase benefits both providers and members and will further support the delivery of these critical services to those in need. The Department is seeking and anticipates approval from the Centers for Medicare and Medicaid Services (CMS) for the MAT rate increase. The Department published a Notice of MaineCare Reimbursement Methodology Change on June 28, 2019 notifying providers of this increase and is awaiting approval of a state plan amendment. Pending that approval, the Department will reimburse MAT services at the increased rate retroactive to July 1, 2019. Additionally, this rulemaking will increase the rates of reimbursement in Chapter III for Functional Family Therapy (FFT), Multisystemic Therapy (MST), Multisystemic Therapy for Problem Sexualized Behaviors (MST-PSB) by 20% effective January 1, 2020 in accordance with Resolves 2019, Ch. 110, Resolve, To Increase Funding for Evidence-based Therapies for Treating Emotional and Behavioral Problems in Children (effective January 12, 2020). In approving this legislation (which became law without the Governors signature), the Legislature determined that an immediate effective date was necessary given the rates had "not been adjusted in more than 8 years" and the rates were insufficient to enable some providers to continue to provide services. The Department agrees with and incorporates these findings in support of this emergency rulemaking under 5 M.R.S. 8054. The Department is seeking and anticipates CMS approval for the 20% rate increases for FFT, MST, and MST-PSB services. The Department published a Notice of MaineCare Reimbursement Methodology Change on June 28, 2019 of the intended 20% rate increases with the expectation that the Legislature would approve the increases effective July 1, 2019. The Department believes this notice is sufficient despite the legislation not taking effect until January 12, 2020. Pending CMS approval, the Department will reimburse FFT, MST, and MST-PSB services at increased rates retroactive to January 1, 2020. Additionally, following the completion of the rate study directed by Resolves 2019, Ch. 110 and completed by Burns and Associates, the Department has developed new increased rates for MST, MST-PSB, and FFT. The additional funding has been approved for the FY2021 state budget pursuant to P.L. 2019, Ch. 616, An Act Making Supplemental Appropriations and Allocations for the Expenditures of State Government, General Fund and Other Funds and Changing Certain Provisions of Law Necessary to the Proper Operations of State Government for the Fiscal Years Ending June 30, 2020 and June 30, 2021 (effective March 18, 2020). Through the rate study process and in line with the Legislatures directive in the Resolve, the Department has made the determination to switch reimbursement from quarter hour billing to a weekly case rate to reflect the requirements for the evidence-based models. Concurrent with these rate changes in Chapter III, in Chapter II, the Department has ended Collateral Contacts for MST, MST-PSB, and FFT as these services have been incorporated into the new weekly case rate. The Department has also adopted minimum contact standards for providers to provide guidance to providers accessing this new weekly case rate. In Chapter III, the Department has deleted the prior quarter hour codes and added in the new weekly codes and rates. In response to financial challenges and civil emergency created by the COVID-19 pandemic, the Department has advanced the increased rates from the anticipated July 1, 2020 start date retroactively to May 1, 2020, in order to provide financial relief, to support stability in the workforce, and to increase access to members in need. Because of this, the Department has determined emergency rulemaking is necessary to support these providers and members receiving these services under 5 M.R.S. 8054 The Department published a Notice of MaineCare Reimbursement Methodology Change on April 30, 2020 of the intended rate increases and intends to file a State Plan Amendment within the quarter. Pending CMS approval, the Department will reimburse MST, MST-PSB, and FFT at increased weekly rates retroactive to May 1, 2020. Finally, P.L. 2019, Ch. 616 also included funding for the Department to increase rates for certain services effective July 1, 2020. In response to the COVID-19 emergency and hardships created during this period of civil emergency, the Department has made the decision to advance these rate increases to be effective retroactively to April 1, 2020. The rate changes include an increase for physicians delivering medication management, and an increase for Behavioral Health Professionals providing Home and Community-based Treatment (HCT) services. In order for physicians to access the increased rate of reimbursement, they will be required to use the AF modifier on their claims. The Department has determined emergency rulemaking is necessary to support these providers and members receiving these services under 5 M.R.S. 8054. The Department published a Notice of MaineCare Reimbursement Methodology Change on March 31, 2020 of the intended rate increases and intends to file a State Plan Amendment within the quarter. Pending CMS approval, the Department will reimburse Behavioral Health Professionals delivering HCT and physicians delivering Medication Management at increased rates retroactive to April 1, 2020. This emergency rulemaking will take effect upon filing with the Secretary of State and will remain in effect for ninety days. 5 M.R.S. 8052(6), 8054(3). To avoid a lapse, the Department is concurrently proposing non-emergency routine technical changes. http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents. EFFECTIVE DATE: 5/21/20 AGENCY CONTACT PERSON: Dean Bugaj, Comprehensive Health Planner AGENCY NAME: Division of Policy ADDRESS: 109 Capitol Street, 1 State House Station Augusta, Maine 04333-0011 EMAIL: dean.bugaj@maine.gov TELEPHONE: (207)-624-4045 FAX: (207) 287-1864 TTY users call Maine relay 711

Comment deadline past No comment deadline | Posted: May 22, 2020

MaineCare Benefits Manual, Ch. I, Section 5, COVID-19 Public Health Emergency Services

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AGENCY: Department of Health and Human Services, Office of MaineCare Services CHAPTER NUMBER AND TITLE: 10-144 C.M.R. Chapter 101, MaineCare Benefits Manual, Ch. I, Section 5, COVID-19 Public Health Emergency Services ADOPTED RULE NUMBER: CONCISE SUMMARY: This emergency rulemaking institutes measures, effective immediately, to expedite and improve access to medical care for MaineCare members due to the 2019 Novel Coronavirus (COVID-19). Pursuant to 5 M.R.S. Sections 8054 and 8073, the Department has determined that immediate adoption of this rule is necessary to avoid a potentially severe and immediate threat to public health, safety or general welfare. The Department's findings of emergency are set forth in detail in the Emergency Basis Statement. Maine is facing a substantial public health threat posed by the global spread of COVID-19. On March 11, 2020 the World Health Organization declared COVID-19 a worldwide pandemic. On March 15, 2020, Governor Janet T. Mills declared a state of civil emergency in Maine. On March 20, 2020, the Department implemented the first COVID-19 Public Health Emergency Services rule (the "COVID-19 Rule"). This is the second set of emergency changes to the COVID-19 Rule (the Second COVID-19 Rule). On April 28, 2020, the Governor issued Executive Order No. 48 FY 19/20, An Order Modifying Certain Procedural Requirements for Emergency Rulemaking to Maximize Federal COVID-19 Funding for MaineCare (the Executive Order). Pursuant to 5 M.R.S. 8054 and 8073, and the Executive Order, this single emergency rulemaking implements temporary changes to various sections of the MaineCare Benefits Manual (MBM) in order to expedite and improve access to medical care for MaineCare members in light of the substantial public health threat posed by COVID-19. The COVID-19 Rule impacts the following sections of MaineCare policy: Chapter I, Section 1 (General Administrative Policies and Procedures); Chapter 1, Section 4 (Telehealth Services); Chapter II, Section 12 (Consumer-Directed Attendant Services); Chapter II, Section 17 (Community Support Services); Chapters II and III, Section 31 (Federally Qualified Health Center Services); Chapters II and III, Section 40 (Home Health Services); Chapters II and III, Section 45 (Hospital Services); Chapter II, Section 55 (Laboratory Services); Chapter II, Section 60 (Medical Supplies and Durable Medical Equipment); Chapter II, Section 67 (Nursing Facility Services); Chapters II and III, Section 94 (Early and Periodic Screening, Diagnosis and Treatment Services); Chapters II and III, Section 96 (Private Duty Nursing and Personal Care Services); Chapter III, Section 97 (Private Non-Medical Institution Services); Chapter X, Section 3 (Katie Beckett Benefit); and Chapter X, Section 1 (Benefit for People Living with HIV/AIDS). This emergency rulemaking implements the following changes to the COVID-19 Rule: The Department is waiving co-payments for some MaineCare services for Consumer Directed Attendant Services and Private Duty Nursing, Personal Care Services, and under the Benefit for People Living with HIV/AIDS. The Department is waiving all enrollment fees, premiums, and similar charges for all beneficiaries. The Department is authorizing and adding Advanced Practice Providers to prescribe Durable Medical Equipment. The Department is waiving the requirement that an MD, DO, PA, or APRN must prescribe an order for hearing aids. A note from an audiologist will justify medical necessity. The Department is authorizing Advanced Practice Providers as qualified providers to order and recertify a Plan of Care for Home Health Services. The Department is adding various CPT coverage codes to Telehealth Services. The Department is allowing, under Bright Futures Health Assessment Visits in Early and Periodic Screening, Diagnosis and Treatment, for one additional health assessment visit per member within a year following an initial assessment via Telehealth for each age shown on the MaineCare Bright Futures periodic health assessment schedule. The Department is allocating a special supplemental pool for privately owned and operated Acute Care Non-Critical Access Hospitals and Critical Access Hospitals. The Department is increasing reimbursement under Private Non-Medical Institution Services for Substance Abuse Treatment Facilities from 3/1/2020 to 5/31/2020. The Department is covering the cost of testing and diagnosis of COVID-19 for a new uninsured eligibility group. The Department, under Community Support Services, is allowing, for Members who require annual verification, the retention of eligibility through previously-rendered diagnoses and clinical judgment. The Department, under Community Support Services, is changing the verification of Eligibility Requirements from within 60 days of the start of the date of services. If eligibility is not submitted by close of business on day 60, MaineCare will cease payment for services under this section on day 61. The Department is extending Personal Support Specialist training requirements under Private Duty Nursing and Personal Care Services. The Department is waiving the Preadmission Screening and Resident Review (PASRR) requirement for Nursing Facility Services. Except as otherwise noted in the COVID-19 Rule, the changes shall be retroactive to March 18, 2020. The Executive Order suspended and modified the relevant provisions of the MAPA in order for these emergency rule changes to: (1) remain in effect until the later of the end of the Federal Proclamation of Emergency or the end of CMSs approval of the MaineCare program changes, even if that period exceeds ninety days; and (2) automatically repeal upon termination of the Federal Proclamation of Emergency or the end of CMSs approval of the MaineCare program changes (whichever is later), without further rulemaking by the Department. In the event of conflict between the COVID-19 Rule and any other MaineCare rule, the terms of this rule supersede other rules and shall apply. http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents. EFFECTIVE DATE: 5/13/2020 AGENCY CONTACT PERSON: Derrick Grant AGENCY NAME: Division of Policy ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 EMAIL: derrick.grant@Maine.gov TELEPHONE: (207)-624-6931 FAX: (207) 287-1606 TTY users call Maine relay 711

Comment deadline past No comment deadline | Posted: May 14, 2020